Running on Pins and Needles: Cartilage Holes in My 17-Year-Old

POSTED ON 5/21/2017 IN Results BY Christopher Centeno

Several years ago, my oldest son began reporting knee pain and limping. That began a long ordeal that finally ended yesterday. Let me explain.

My Son's Knees

My oldest son is named after my father. He was a premature twin that weighed 2 pounds 4 ounces and came home from the hospital on oxygen. Hence, his first words were a big deal, as were his first steps.

Several years ago, he began limping. Like all fathers, I initially ignored his complaints, thinking they would go away. Soon thereafter, I saw him struggle to get up our stairs and knew it was time for an MRI. That image rocked my world—he had holes in the cartilage in both knees. I knew, from treating many kids with cartilage defects and seeing them later in life, that his options were limited. The traditional orthopedic-surgery approach is usually microfracture or a cartilage-transfer procedure. However, I had seen these kids age, and almost all of them end up with early arthritis by their twenties or thirties. I so didn't want that for my son.

Complicating all of this was the fact that his school has frequent trips. These aren't short jaunts as on these multiday trips, he is required to carry his own 40-pound backpack and hike for miles in the mountains! Given that the stairs were getting tough, this was never going to happen.

Regen Med vs. Surgery

As you might imagine, when I found out my son had holes in his cartilage, surgery was not going to be the first option. However, his route back to full health would be a winding road and not a shortcut.

My first question was obvious: how did this happen? While he was an avid trampoline jumper, so was my younger son, who didn't have this issue. However, he was on Accutane for acne, so that's where my search began. Sure enough, that drug has some reports of disturbing joint, bone, and cartilage maintenance. So while we'll never know for sure, this was my best educated guess.

Second, what would we do? My first thought was to try platelet rich plasma (PRP) as that's the least invasive orthobiologic we offer. In addition, at his young age, if PRP could heal a cartilage lesion, it would obviously be in a kid this young. So he came into the clinic to get a PRP injection, and I waited. Regrettably, there was no change in his limp.

Next up was a same-day stem cell procedure. Given that this was still less invasive than drilling holes in his knee and placing him on crutches for a few months, we next went that direction. While we have seen many cartilage holes heal with this type of care, maybe due to the Accutane, this didn't work for Joe.

That left only one therapy that we offered that might work. So Joe and I went down to our licensed Grand Cayman site to get his cells grown to bigger numbers. Thankfully, after getting the cultured cells injected, Joe began to mount a recovery. While I could have gotten a repeat MRI at any time, I never did that. Maybe some small part of me couldn't deal with seeing a repeat MRI on the outside chance that this didn't work and Joe would need a surgery that I knew would leave him with early arthritis as a young man.

Running on Pins and Needles

Over the next few years, every time Joe would go on a school backpacking trip, I would hold my breath. Would this be the trip that was just too much on his knees? Would this be the one when he came back limping or on crutches? A few months ago, my wife decided that she and Joe would enter a local half-marathon trail run in the Denver foothills. I again cringed. However, Joe threw himself into training hard, so I had to accept that this trail run would be the ultimate test of whether the procedure had been effective.

So yesterday, for three long hours, as Joe was on that trail, I held my breath. The fact that we had a record late snow a few days prior and that the trail was a mix of heavy snow and muddy slop, didn't make me feel any better. In my head, Joe was literally running on pins and needles. Standing at the finish line, I checked every runner in the distance who could be Joe to see if that guy was limping. I had thoughts of asking the race organizers what would happen if somebody got stuck out on the trail. How would we find him? So as he appeared on the horizon, I was finally able to breathe. As he crossed the finish line, my first question was, "How are those knees?" He didn't hesitate when he said "fine." That was likely the happiest patient outcome of my career!

The upshot? It's awful to see your kids suffer. Even worse when you know that traditional orthopedic surgery has nothing to offer that doesn't also come with big side effects. I am so grateful that Joe was able to cross that finish line, and in my mind, I can now say that Joe is finally healed. So this patient outcome has a special meaning to me!    

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